Background Gastric hyperplastic polyps (GHPs) have a risk of neoplastic transformation reaching 5 %. Current endoscopic resection techniques appear suboptimal with a high risk of local recurrence. This study assessed the outcomes of endoscopic resection for GHPs and identified risk factors for recurrence and neoplastic transformation. Methods This retrospective, multicenter, European study included adult patients with at least one GHP ≥ 10 mm who underwent endoscopic resection and at least one follow-up endoscopy. Patients with recurrent GHPs or hereditary gastric polyposis were excluded. All data were retrieved from the endoscopy, pathology, and hospitalization reports. Results From June 2007 to August 2018, 145 GHPs in 108 patients were included. Recurrence after endoscopic resection was 51.0 % (74 /145) in 55 patients. R0 resection or en bloc resection did not impact the risk of polyp recurrence. In multivariate analysis, cirrhosis was the only risk factor for recurrence (odds ratio [OR] 4.82, 95 % confidence interval [CI] 1.33 – 17.46; P = 0.02). Overall, 15 GHPs (10.4 %) showed neoplastic transformation, with size > 25 mm (OR 10.24, 95 %CI 2.71 – 38.69; P < 0.001) and presence of intestinal metaplasia (OR 5.93, 95 %CI 1.56 – 22.47; P = 0.01) being associated with an increased risk of neoplastic transformation in multivariate analysis. Conclusions Results confirmed the risk of recurrence and neoplastic transformation of large GHPs. The risk of neoplastic change was significantly increased for lesions > 25 mm, with a risk of high grade dysplasia appearing in polyps ≥ 50 mm. The risk of recurrence was high, particularly in cirrhosis patients, and long-term follow-up is recommended in such patients.

SUMMARY The effect of a 90% small bowel resection on the exocrine pancreas was investigated over a three month period in adult Wistar rats. Control animals underwent a sham-resection consisting of a transection and reanastomosis of the small intestine. After jejunoileal resection, the wet weight of the gland increased significantly (52%) from the 15th day. The The first group (54 rats) served as sham-resected control animals and the second group (48 rats) underwent a 90 % resection of the small bowel. OPERATIVE PROCEDUREAfter a 12 hour fast, a 90 % jejunoileal resection was performed under ether anaesthesia. The peritoneal cavity was entered through a midline incision and the intestinal tract, from the ligament of Treitz to the ileocaecal junction, was exteriorised. The length of the combined jejunum and ileum, measured using slight tension, was nearly 100 cm. Subsequently, 90% of the small intestine was removed beginning 5 cm distal to the ligament of Treitz. The remaining intestine was anastomosed by end-to-end enteroenterostomy using eight separate sutures of 6-0 silk. Sham-resections consisted of transection and reanastomosis of the small intestine either 5 cm below the ligament of Treitz or 5 cm from the ileocaecal junction. After surgery, the animals were weighed, then allowed tap water and fed a standard rat chow-diet ad libitum (UAR, ref. A 03, Villemoisson-sur-Orge, France). After a 12 hour fast, the animals of both groups were weighed and killed at two weekly intervals from 15 days to three months. At each period, the sham-and resected group consisted respectively of nine and eight animals. Food intake was measured at two day intervals before and after surgery. 207 on 12 May 2018 by guest. Protected by copyright.

Endoscopic submucosal dissection (ESD) is an effective, safe technique for treating gastric lesions [1]. Hyperplastic polyps have an underestimated risk for malignancy, which has been reported to be 3.7 % in 809 lesions measuring more than 1 cm [2]. Thus, complete en bloc resection with ESD is an option to avoid local recurrence [3], particularly when hyperplasia is associated with dysplasia. We report the case of a 68-year-old man who underwent a complete R0 resection by ESD of a 2-cm hyperplastic polyp with low grade dysplasia that was located on the posterior wall of the antrum (• " Fig. 1). The specimen was 6 cm in size, with large safety margins (• " Fig. 2). Follow-up endoscopy 3 months later revealed good scarring without any local recurrence histologically. Biopsy revealed antral atrophic gastritis and intestinal metaplasia. At 1-year follow-up, extensive recurrence had appeared on the whole posterior wall of the antrum that measured more than 8 cm and crossed the pylorus (• " Fig. 3, • " Fig. 4). We attempted a new ESD procedure, but severe fibrosis prevented submucosal access. To differentiate recurrence from a profuse scarring process, we performed a snare resection of a 25-mm fragment, which confirmed hyperplasia without dysplasia, in addition to granulation scarring tissue. Such recurrence has previously been described after surgery, but never after endoscopic resection [4]. Because of the significant size of the lesion, the fibrosis, and the potential for malignancy, surgery was scheduled. Various risk factors for hyperplastic gastric polyps have been proposed, such as chronic active gastritis and concomitant Helicobacter pylori infection [5]. In our patient, earlier biopsies never revealed such an infection, but he had a long history of proton pump inhibitor use. To summarize, we report a profuse recurrence of hyperplasia after curative en bloc ESD of a hyperplastic polyp with low grade dysplasia. This uncommon evolution might be linked to the large area of resection by ESD, which led to a significant scarring process. Long-term followup appears to be justified in patients who undergo resections of this type. Endoscopy_UCTN_Code_CPL_1AH_2AZCompeting interests: None This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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